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Renneberg B, Hutsebaut J, Berens A, De Panfilis C, Bertsch K, Kaera A, Kramer U, Schmahl C, Swales M, Taubner S, Alvarez MM, Sieg J. Towards an informed research agenda for the field of personality disorders by experts with lived and living experience and researchers. Borderline Personal Disord Emot Dysregul 2024; 11:14. [PMID: 38973006 PMCID: PMC11229301 DOI: 10.1186/s40479-024-00257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND We describe a collection of themes for a research agenda for personality disorders that was originally formulated for the ESSPD Borderline Congress in 2022. METHODS Experts with lived and living experience (EE), researchers and clinicians met virtually, exchanged ideas and discussed research topics for the field of personality disorders. The experts - patients, relatives, significant others - named the topics they thought most relevant for further research in the field. These topics were presented at the ESPPD conference in October 2022. RESULTS The five top themes were: 1. Prevention, early detection and intervention, 2. Recovery beyond symptom improvement, 3. Involvement of relatives in treatment, 4. Gender dysphoria, and 5. Stigma. CONCLUSIONS In general, the topics reflect current issues and changes in societal values. Overarching aims of research on these topics are the improvement of social participation and integration in society, better dissemination of research, and better information of the general public and political stakeholders.
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Affiliation(s)
- Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany.
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany.
| | - Joost Hutsebaut
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Ann Berens
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
- Collaborative Antwerp Psychiatric Research Institute, Universiteit Antwerp, Antwerp, Belgium
| | - Chiara De Panfilis
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Katja Bertsch
- Department of Psychology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Andres Kaera
- Department of Psychiatry, Kanta-Häme Central Hospital, Wellbeing Services County of Kanta-Häme, Hämeenlinna, Finland
| | - Ueli Kramer
- Department of Psychiatry, Institute of Psychotherapy and General Psychiatry Service, Université de Lausanne, Lausanne, Switzerland
| | - Christian Schmahl
- Department of Psychosomatic Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim, Mannheim, Germany
| | - Michaela Swales
- North Wales Clinical Psychology Programme, Bangor University, Bangor, Wales
| | - Svenja Taubner
- Institute for Psychosocial Prevention, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Mariana Mendoza Alvarez
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
- Collaborative Antwerp Psychiatric Research Institute, Universiteit Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Julia Sieg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
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Fonseca-Baeza S, García-Alandete J, Marco JH, Pérez Rodríguez S, Baños RM, Guillén V. Difficulties in emotional regulation mediates the impact of burden on quality of life and mental health in a sample of family members of people diagnosed with Borderline Personality Disorder. Front Psychol 2023; 14:1270379. [PMID: 38054179 PMCID: PMC10694221 DOI: 10.3389/fpsyg.2023.1270379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
Background Although it has been suggested that family members of persons suffering from Borderline Personality Disorder (BPD) endure high levels of burden, however, the process and the impact of this burden in their lives, and specifically the relation between the burden and emotional regulation has not been broadly investigated among this population. The main objective of this study is to examine the impact of burden on quality of life and depression, anxiety and stress, as mediated by difficulties in emotional regulation in family members of persons diagnosed with BPD. Method Participants were 167 family members of persons diagnosed with BPD. The Burden Assessment Scale, Difficulties in Emotion Regulation Scale, Multicultural Quality of Life Index, and Depression Anxiety Stress Scale-21 were filled out. Mediation analysis was conducted using the Maximum Likelihood estimator, bootstrap method and listwise deletion for missing data. Results Burden showed a significant, negative effect on quality of life and positive on depression, anxiety and stress. Difficulties in emotion regulation significantly mediated these relations. After accounting for the mediating role of difficulties in emotion regulation, burden still had an impact on quality of life, depression, anxiety and stress. Women showed a higher level in both burden and stress than men. The caregivers with secondary and higher studies showed higher levels in burden than those with no studies. Not significant differences in burden, emotion regulation, depression, anxiety and stress were found related to marital status. Conclusion Difficulties in emotion regulation mediate the relations between burden and quality of life, depression, anxiety, and stress. Family members could engage in group interventions designed specifically for family members of people with BPD, oriented toward understanding the disorder or learning skills.
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Affiliation(s)
- Sara Fonseca-Baeza
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Joaquín García-Alandete
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - José Heliodoro Marco
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Sandra Pérez Rodríguez
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Rosa M. Baños
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Verónica Guillén
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Betts JK, Seigerman MR, Hulbert C, McKechnie B, Rayner VK, Jovev M, Cotton SM, McCutcheon LK, McNab C, Burke E, Chanen AM. A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder features. Aust N Z J Psychiatry 2023; 57:1453-1464. [PMID: 37170885 PMCID: PMC10619189 DOI: 10.1177/00048674231172108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Preliminary evidence indicates that interventions designed to support family and friends ('carers') of young people with early-stage borderline personality disorder effectively improve carer outcomes. None of these interventions have been tested in a randomised controlled trial. METHOD This clustered, partially nested, randomised controlled trial was conducted at Orygen, Melbourne, Australia. Carers of young people (aged 15-25 years) with borderline personality disorder features were randomly assigned as a unit in a 1:1 ratio, balanced for young person's sex and age, to receive a 15-day intervention comprising: (1) the three-session, in-person, Making Sense of BPD (MS-BPD) multi-family group programme, plus two self-directed online psychoeducational modules (MS-BPD + Online, n = 38), or (2) the two self-directed online psychoeducational modules alone (Online, n = 41). The primary outcome was 'negative experiences of care', measured with the Experience of Caregiving Inventory, at the 7-week endpoint. RESULTS A total of 79 carers were randomised (pool of 281, 197 excluded, 94 declined) and 73 carers (51 females [69.9%], Mage = 43.8 years [standard deviation, SD = 12.9], MS-BPD + Online n = 35 [47.9%], Online n = 38 [52.1%]) provided follow-up data and were included in the intent-to-treat analysis. The intent-to-treat (and per protocol) analyses did not find any significant differences between the groups on the primary (d = -0.32; 95% confidence interval = [-17.05, 3.97]) or secondary outcomes. Regardless of treatment group, caregivers improved significantly in their personality disorder knowledge. CONCLUSION Delivering MS-BPD in conjunction with an online psychoeducational intervention was not found to provide additional benefit over and above access to an online intervention alone. In accordance with national guidelines, carer interventions should be routinely offered by youth mental health services as part of early intervention programmes for borderline personality disorder. Further research is warranted into which interventions work for whom, carers' preferences for support and barriers to care.
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Affiliation(s)
- Jennifer K Betts
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mirra R Seigerman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Victoria K Rayner
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Martina Jovev
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sue M Cotton
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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4
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Hayes A, Dempsey M, Kells M, Murphy M. The relationship between social support, coping strategies and psychological distress and positive mental well-being in carers of people with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2023; 10:31. [PMID: 37821995 PMCID: PMC10568807 DOI: 10.1186/s40479-023-00237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Informal carers of people with BPD experience high levels of burden and psychological distress relative to other populations. There is a scarcity of research evidencing the influence of modifiable factors on carer outcomes to inform interventions. This study aimed to investigate the relationship between social support, coping strategies and psychological distress and positive mental well-being in this carer population. METHODS In this cross-sectional study, 1207 carers completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, and the Coronavirus Anxiety Scale. Data for 863 participants who met the inclusion criteria were analysed. RESULTS Carers reported low positive mental well-being and high psychological distress. Perceived social support and several coping strategies were significant unique predictors of psychological distress and positive mental well-being. Perceived social support and positive reframing were the strongest predictors of higher positive mental well-being and lower psychological distress. Self-blame, behavioural disengagement and substance use were the strongest predictors of adverse outcomes. CONCLUSIONS The findings evidence modifiable factors that may be used to improve informal carer outcomes and indicate that carer interventions may be improved by focusing on reducing the use of self-blame, behavioural disengagement and substance use, and development of quality social support and skills to positively reframe caregiving situations.
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Affiliation(s)
- Aoife Hayes
- School of Applied Psychology, University College Cork, Cork, Ireland.
| | - Maria Dempsey
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mary Kells
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
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Robin M, Bellone L, Belbèze J, Kazemian K, Radjack R, Corcos M. Three-level containment model of hospitalized adolescents with borderline pathology: a holistic therapeutic perspective. Front Psychiatry 2023; 14:1110788. [PMID: 37608992 PMCID: PMC10441123 DOI: 10.3389/fpsyt.2023.1110788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/16/2023] [Indexed: 08/24/2023] Open
Abstract
Borderline personality disorders account for 50% of adolescent hospitalization cases in psychiatry. The severity and psychopathological complexity of these symptoms indicate the need for inclusive models of understanding. Adopting a holistic approach allows for the consideration of not only the patient's environment, but also their position within that environment and their life history. In this article, a model based on the concept of therapeutic containment at three levels is presented. Global containment refers to the mindset and organization of the institution that provides care, which is itself a part of society at a specific time. Local containment focuses on understanding and therapeutic interventions within the immediate social environment of the individual. Lastly, individual containment encompasses the development of independent processes during the course of care. These three levels are integrated in the hospital treatment of borderline personality disorders, forming a trans-theoretical approach.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Villejuif, France
- Paris Cité University, Paris, France
| | - Laura Bellone
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Koucha Kazemian
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Rahmeth Radjack
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Villejuif, France
- Paris Cité University, Paris, France
- Maison de Solenn, Department of Adolescent Psychiatry, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
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Guillén V, Bolo S, Fonseca-Baeza S, Pérez S, García-Alandete J, Botella C, Marco JH. Psychological assessment of parents of people diagnosed with borderline personality disorder and comparison with parents of people without psychological disorders. Front Psychol 2023; 13:1097959. [PMID: 36710828 PMCID: PMC9880188 DOI: 10.3389/fpsyg.2022.1097959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
BackgroundTo date, several evidence-based interventions have been created to help relatives of people with Borderline Personality Disorder (BPD), but few studies have analyzed the clinical situation of the family members. The aim of this study was twofold: (1) to explore the clinical symptomatology in a sample of parents of people diagnosed with BPD and compare them with a sample of a sample of people without a relative with a personality disorder, (2) to explore whether the parents of people diagnosed with BPD have psychopathology related to personality disorders (PD) or meet the diagnostic criteria for PD.MethodParticipants were 42 (39.6%) fathers and 64 (60.4%) were mothers and mothers (n = XX, −%) of people diagnosed with BPD, who were selected from a specialized PD unit for treatment. The sample of people without a relative with a PD was obtained from social network announcements. To test for differences between the two groups, Student’s t tests were performed for quantitative variables, and Chi-square tests were performed for categorical variables. Cohen’s d was calculated as a measure of the effect size.ResultsParents of people with BPD showed greater depressive and anxious symptomatology, higher levels of expressed emotion, and worse quality of life than the sample of people without a relative with a personality disorder. In addition, a high percentage of the parents of people diagnosed with BPD (50%) met the diagnostic criteria for different PD.ConclusionParents of people diagnosed with BPD may need psychological help in various aspects. Therapists are therefore advised to bear in mind the importance of carrying out a psychological assessment of family members and, if necessary, to offer psychological intervention. It is crucial to invite the family to be part of the treatment, since they can be part of the solution.Clinical Trial registration: ClinicalTrials.gov ID, NCT04160871 (registered November 15, 2019).
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Affiliation(s)
- Verónica Guillén
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain,*Correspondence: Verónica Guillén,
| | - Sara Bolo
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sara Fonseca-Baeza
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sandra Pérez
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Joaquín García-Alandete
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain,Department of Psicología Básica, Clínica y Psicobiología, Universidad Jaime I de Castellón, Plana, Spain
| | - José Heliodoro Marco
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain
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Fitzgeraldson E, Kay-Lambkin F, Harding N, McNaughton KM, Triandafilidis Z, Heath J, Lyford B, Charnley J, Fitzpatrick S. Supports and Interventions for Carers of a Person with Depressive or Anxiety Symptomology: A Systematic Review. EUROPES JOURNAL OF PSYCHOLOGY 2022; 18:476-493. [PMID: 36605087 PMCID: PMC9780730 DOI: 10.5964/ejop.6407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/03/2021] [Indexed: 12/05/2022]
Abstract
An increasing body of research attests to the capacity of evidence-based interventions to improve outcomes for informal carers. A review of suitable supports and interventions for carers of a person with depressive or anxiety symptomology is timely. This systematic review explores intervention suitability evidence for this carer group. Searches for relevant primary studies were conducted in six databases across a 15-year timeframe (October 2004-October 2019). Studies were assessed and compared narratively and thematically. Qualitative themes were synthesised with quantitative studies to explore the extent to which carer preferences were embedded in interventions. The initial literature search produced 13,183 studies. Six studies-three randomised controlled trials (RCTs) and three mixed-method studies-were included following a double-blinded screening process, a review of reference lists and risk of bias assessment. Included studies contributed either intervention efficacy or acceptability evidence. The synthesis of qualitative themes with quantitative studies found that carer-specific needs and targeted psychoeducation were featured in interventions from all six quantitative studies. Current evidence for appropriate supports and interventions for this carer group is limited. The review uncovers a lack of interventions for carers of a person with anxiety symptomology and limited intervention suitability evidence for carers of a person with depressive symptomology. More research is needed to explore the needs and preferences of this carer group, and how best to support them.
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Affiliation(s)
| | - Frances Kay-Lambkin
- University of Newcastle, Newcastle, Australia,NHMRC Centre for Research Excellence in Mental Health & Substance Abuse, Macquarie University, Sydney, Australia,Hunter Medical Research Institute, Newcastle, Australia,Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia,Society for Mental Health Research, Victoria, Australia,International Society for Research on Internet Interventions, Sanford, NC, USA
| | - Natasha Harding
- University of Newcastle, Newcastle, Australia,Everymind, Newcastle, Australia
| | - Kimie M. McNaughton
- University of Newcastle, Newcastle, Australia,Hunter Medical Research Institute, Newcastle, Australia,Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia
| | - Zoi Triandafilidis
- University of Newcastle, Newcastle, Australia,Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia
| | - Jacinta Heath
- Child and Adolescent Mental Health Service, Hunter New England Health, Sydney, Australia
| | - Bronte Lyford
- University of Newcastle, Newcastle, Australia,Everymind, Newcastle, Australia
| | - Janine Charnley
- University of Newcastle, Newcastle, Australia,Hunter Medical Research Institute, Newcastle, Australia,Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia,Society for Mental Health Research, Victoria, Australia
| | - Sally Fitzpatrick
- University of Newcastle, Newcastle, Australia,Everymind, Newcastle, Australia,Centre for Emotional Health, Macquarie University, Sydney, Australia
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Fernández-Felipe I, Guillén V, Castilla D, Navarro-Haro MV, García-Palacios A. A smartphone application of "Family Connections" to increase the use of skills and improve psychological symptoms in relatives of people with borderline personality disorder: A study protocol for a randomized controlled trial. Internet Interv 2022; 29:100546. [PMID: 35607385 PMCID: PMC9123206 DOI: 10.1016/j.invent.2022.100546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Verónica Guillén
- University of Valencia and Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| | | | | | - Azucena García-Palacios
- Universitat Jaume I and Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
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9
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Cotton SM, Betts JK, Eleftheriadis D, Filia K, Seigerman M, Rayner VK, McKechnie B, Hulbert CA, McCutcheon L, Jovev M, Bendall S, Burke E, McNab C, Mallawaarachchi S, Alvarez-Jimenez M, Chanen AM, Gleeson JF. A comparison of experiences of care and expressed emotion among caregivers of young people with first-episode psychosis or borderline personality disorder features. Aust N Z J Psychiatry 2022; 56:1142-1154. [PMID: 34628949 DOI: 10.1177/00048674211050299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Caregivers of individuals with severe mental illness often experience significant negative experiences of care, which can be associated with higher levels of expressed emotion. Expressed emotion is potentially a modifiable target early in the course of illness, which might improve outcomes for caregivers and patients. However, expressed emotion and caregiver experiences in the early stages of disorders might be moderated by the type of severe mental illness. The aim was to determine whether experiences of the caregiver role and expressed emotion differ in caregivers of young people with first-episode psychosis versus young people with 'first-presentation' borderline personality disorder features. METHOD Secondary analysis of baseline (pre-treatment) data from three clinical trials focused on improving caregiver outcomes for young people with first-episode psychosis and young people with borderline personality disorder features was conducted (ACTRN12616000968471, ACTRN12616000304437, ACTRN12618000616279). Caregivers completed self-report measures of experiences of the caregiver role and expressed emotion. Multivariate generalised linear models and moderation analyses were used to determine group differences. RESULTS Data were available for 265 caregivers. Higher levels of negative experiences and expressed emotion, and stronger correlations between negative experiences and expressed emotion domains, were found in caregivers of young people with borderline personality disorder than first-episode psychosis. Caregiver group (borderline personality disorder, first-episode psychosis) moderated the relationship between expressed emotion and caregiver experiences in the domains of need to provide backup and positive personal experiences. CONCLUSION Caregivers of young people with borderline personality disorder experience higher levels of negative experiences related to their role and expressed emotion compared with caregivers of young people with first-episode psychosis. The mechanisms underpinning associations between caregiver experiences and expressed emotion differ between these two caregiver groups, indicating that different supports are needed. For borderline personality disorder caregivers, emotional over-involvement is associated with both negative and positive experiences, so a more detailed understanding of the nature of emotional over-involvement for each relationship is required to guide action.
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Affiliation(s)
- Sue M Cotton
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jennifer K Betts
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Dina Eleftheriadis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - Kate Filia
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Victoria K Rayner
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Carol Anne Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Louise McCutcheon
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Sarah Bendall
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Catharine McNab
- Mindful Centre for Training and Research in Developmental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sumudu Mallawaarachchi
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew M Chanen
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - John Fm Gleeson
- Mindful Centre for Training and Research in Developmental Health, The University of Melbourne, Parkville, VIC, Australia
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10
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Marco JH, Fonseca S, Fernandez-Felipe I, García-Palacios A, Baños R, Perez S, Garcia-Alandete J, Guillen V. Family connections vs treatment at usual optimized in the treatment of relatives of people with suicidal behavior disorder: study protocol of a randomized control trial. BMC Psychiatry 2022; 22:335. [PMID: 35570289 PMCID: PMC9107725 DOI: 10.1186/s12888-022-03965-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relatives of people diagnosed with suicidal behavior disorder (SBD) feel guilty, afraid, hopeless, depression and anxiety. It is necessary to help the relatives of people with SBD to reduce their discomfort and burden. Family Connections (FC) is a program that has been shown to be effective in reducing burden, depression, and anxiety, and increasing dominance and validating behaviors in relatives of people with borderline personality disorder. However, there are no RCTs that demonstrate the efficacy of the FC program in patients with SBD. Our research team adapted FC for relatives of people with SBD for delivery in the Spanish population (FC-SBD). The FC-SBD program contains 12 two-hour sessions held once a week. The first aim is to verify the efficacy of the FC-SBD intervention for relatives of people diagnosed with SBD in a randomized control trial with a Spanish sample. The second objective is to analyze the feasibility and acceptance of FC-SBD in relatives. The third aim is to analyze whether the changes produced in the psychological variables in the relatives after the intervention are related to changes in the psychological variables of the patients. This paper presents the study protocol. METHODS The study design consists of a two-arm randomized controlled trial with two conditions: FC-SBD or Treatment as usual optimized (TAU-O). Participants will be relatives of patients who meet DSM-5 criteria for SBD. The caregivers` primary outcome measures will be the BAS. Secondary outcomes will be DASS-21, FES, DERS, QoL. The patient's primary outcome measures will be the frequency of critical incidents with the family member with SBD. Secondary measures will be the INQ, PHQ-9, OASIS. Participants will be assessed at pretreatment, post-treatment, and 6-month follow-up. The intention-to-treat principle will be used when analyzing the data. DISCUSSION This study will provide results that confirm the efficacy of the FC-SBD in relatives of people with SBD. These results will also confirm its good acceptance by family members and help us to find out whether it is a good program to improve the prevention of suicidal behaviors in the family environment. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05157607 . Registered 15 December 2021.
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Affiliation(s)
- José H. Marco
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
| | - Sara Fonseca
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Isabel Fernandez-Felipe
- grid.9612.c0000 0001 1957 9153Universitat Jaume I de Castelló, España. Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón, España
| | - Azucena García-Palacios
- grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España ,grid.9612.c0000 0001 1957 9153Universitat Jaume I de Castelló, España. Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón, España
| | - Rosa Baños
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
| | - Sandra Perez
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Joaquín Garcia-Alandete
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Verónica Guillen
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
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11
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Psychoeducational groups for close relatives of patients with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01395-8. [PMID: 35294615 DOI: 10.1007/s00406-022-01395-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/01/2022] [Indexed: 11/03/2022]
Abstract
Psychoeducational groups for family members of patients with schizophrenia have proven to be effective. Borderline personality disorder (BPD) implies serious impairment in interpersonal relationships. Close relatives of individuals with BPD also show high levels of burden and need support. Psychoeducational groups could help to cope with the interactional problems in a relationship with a person with BPD. A manualised psychoeducational programme of 10 group sessions for close relatives of patients with BPD was tested. Measures administered at pretest and after 10 sessions were: perceived burden (IEQ-EU), knowledge about the disorder (WFBBPS-A) and quality of life (WHOQOL-BREF). For formative evaluation, a "Group Therapy Session Questionnaire" (participant and therapist version; GTS-A, GTS-T) was used. A total of 33 persons in three groups took part. Pre-post evaluations revealed a significantly lower level of burden and a significantly better knowledge about the disorder after participating in the psychoeducational group. Reduction of burden correlated significantly with the assessment of patients' symptom severity and carers' level of burden at study entry. There was no change in the quality of life. The participants and therapists generally rated the psychoeducational sessions very positively. The highest ratings were found in the sessions about communication skills and coping with crises. Findings indicate that the psychoeducational programme is well accepted and supportive for persons with close relationships to patients with BPD.
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Gleeson J, Alvarez-Jimenez M, Betts JK, McCutcheon L, Jovev M, Lederman R, Herrman H, Cotton SM, Bendall S, McKechnie B, Burke E, Koval P, Smith J, D'Alfonso S, Mallawaarachchi S, Chanen AM. A pilot trial of moderated online social therapy for family and friends of young people with borderline personality disorder features. Early Interv Psychiatry 2021; 15:1564-1574. [PMID: 33260274 DOI: 10.1111/eip.13094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022]
Abstract
AIM We evaluated the acceptability, usability and safety of Kindred, a novel online intervention for carers of young people with borderline personality disorder (BPD) using a pre-post pilot trial design. The secondary aim explored whether Kindred use was associated with clinical improvements for caregivers on measures of burden of caregiving, stress, expressed emotion, family communication, disability, coping and knowledge of BPD and for patients on measures of severity of BPD symptoms and level of functional impairment. METHODS The trial site was the Helping Young People Early program for young people with BPD at Orygen in Melbourne, Australia. Informed consent was obtained from 20 adult carers (i.e., relatives or friends) and 10 young people aged 15-25 with BPD. Kindred, which was available for 3 months, incorporated online psychoeducation, carer-to-carer social networking and guidance from expert and peer moderators. Assessments were completed at baseline and 3 months follow-up. Multiple indicators of acceptability, usability and safety were utilized. RESULTS Seventeen carers were enrolled in Kindred and eight young people completed baseline measures. A priori acceptability, usability and safety criteria were met. Carer burden, stress, expressed emotion, family communication, quality of life, functioning, coping and perceived knowledge of BPD improved at follow-up. Sixty-six percent of the young people (4/6) reported that they believed Kindred had improved their carers' understanding of BPD. CONCLUSION Kindred was shown to be acceptable, usable and safe, with encouraging improvements in both carer and young person outcomes. Kindred warrants evaluation of its efficacy via an randomized controlled trial.
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Affiliation(s)
- John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Louise McCutcheon
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Reeva Lederman
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Helen Herrman
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Susan M Cotton
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | | | - Peter Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Jesse Smith
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Simon D'Alfonso
- Orygen, Melbourne, Australia.,School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Sumudu Mallawaarachchi
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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13
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Jørgensen MS, Storebø OJ, Poulsen S, Simonsen E. Burden and Treatment Satisfaction among Caregivers of Adolescents with Borderline Personality Disorder. FAMILY PROCESS 2021; 60:772-787. [PMID: 33010045 DOI: 10.1111/famp.12593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the fact that family involvement is encouraged in early interventions for borderline personality disorder (BPD), there is a limited knowledge on the experience of caring for adolescents with BPD. This is an exploratory retrospective study nested within a randomized controlled trial that compared mentalization-based treatment (MBT) in groups to treatment as usual for adolescents with BPD. Caregivers received six MBT-Parents sessions or standard care over one year. Three months after end of treatment (EOT), 75 caregivers (35 in MBT, 40 in TAU) filled out the Burden Assessment Scale, and 71 (34 in MBT, 37 in TAU) the Family Satisfaction Survey. The adolescents filled out the Borderline Personality Features Scale for Children at baseline and after twelve months at EOT. We tested whether caregiver demographics, adolescents' severity of BPD, treatment and adolescents' dropout from treatment predicted levels of caregiver burden and satisfaction with treatment. The caregivers reported high levels of burden on the BAS (M = 40.3, SD = 12.2). Our study suggests that higher BPD severity at EOT among the adolescents predicted caregiver burden (p = .03), whereas higher baseline BPD severity predicted satisfaction with treatment (p = .04) and that biological mothers could be more burdened than other types of caregivers but also might be more satisfied with treatment. Treatment and adolescents' dropout from treatment were not related to caregiver burden or satisfaction with treatment. To help inform future research and to devise appropriate interventions for caregivers and adolescents with BPD, it is important to identify possible predictors of caregiver burden. The results of this initial exploratory study indicate that caregivers (and particularly biological mothers) of adolescents with more severe levels of BPD could be particularly vulnerable toward feelings of burden and therefore are in need of support.
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Affiliation(s)
- Mie Sedoc Jørgensen
- Child and Adolescent Psychiatry, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Child and Adolescent Psychiatry, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Guillén V, Díaz-García A, Mira A, García-Palacios A, Escrivá-Martínez T, Baños R, Botella C. Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review. FAMILY PROCESS 2021; 60:134-144. [PMID: 32304101 DOI: 10.1111/famp.12537] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Carers of patients with borderline personality disorder (BPD) experience high levels of distress. Several studies have been carried out on interventions designed to decrease their burden. However, the evidence from these studies has not been summarized. The objective of this work is to explore the clinical utility of interventions developed for family members of patients with BPD. A systematic review was conducted following the PRISMA guidelines (registration number CRD42018107318), including psychological interventions focused on relatives of patients with BPD. The following databases were used: PsycINFO, PubMed, EBSCOhost, and Web of Science. Two independent researchers reviewed the studies to determine whether the eligibility criteria were met. A total of 2,303 abstracts were identified. After duplicates had been removed, 1,746 studies were screened. Finally, 433 full-text articles were reviewed, yielding 11 studies that satisfied the inclusion criteria. Results show that these interventions with different clinical formats and settings are effective. The quality of the included studies varies, and the empirical support for these programs is still preliminary. The results help to establish a general framework for interventions specifically developed for family members of patients with BPD, but additional efforts should be made to improve the methodological quality of this field of research and more solidly determine the utility of these interventions. Given the paucity of data so far, this information may open up new lines of research to improve the effectiveness of future programs for carers of patients with BPD and help to reduce their burden.
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Affiliation(s)
- Verónica Guillén
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Amanda Díaz-García
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
| | - Azucena García-Palacios
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Tamara Escrivá-Martínez
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
| | - Rosa Baños
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Cristina Botella
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
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15
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Bernard L, Walburg V. Efficacy of a Brief Cognitive-Emotional Group Intervention for Patients with Borderline personality disorder. PSYCHOLOGIE FRANCAISE 2020. [DOI: 10.1016/j.psfr.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Fernández-Felipe I, Guillén V, Marco H, Díaz-García A, Botella C, Jorquera M, Baños R, García-Palacios A. Efficacy of "Family Connections", a program for relatives of people with borderline personality disorder, in the Spanish population: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:302. [PMID: 32539740 PMCID: PMC7296953 DOI: 10.1186/s12888-020-02708-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) experience significant affect regulation difficulties that cause serious consequences in their work, emotional, and social environments. This dysfunctional pattern also produces great suffering and a heavy burden on their relatives. Fortunately, some studies show that treatment of relatives of people with BPD begins to be important in the patients' recovery and in improving family dynamics. One of the treatments that has obtained the most empirical support is Family connections (FC). This 12-session program is an adaptation of different Dialectical Behavior Therapy strategies. To test the efficacy of FC, five uncontrolled clinical trials were conducted, with pre-post treatment and follow-up assessments. The results of these studies and subsequent replications showed an improvement in family attitudes and caregiver burnout. Our research team adapted FC for delivery in the Spanish population. We intend to test the efficacy of this program versus a treatment as usual condition. Moreover, we aim to test the efficacy of this program and study its effectiveness (in terms of participants' acceptance). This paper presents the study protocol. METHODS The study is a randomized controlled trial. The participants will be recruited in a Personality Disorders Unit and randomly assigned to one of two treatment conditions: Family Connections group (FC) or Treatment As Usual (TAU). Primary outcome measures will be the BAS and FAD-GFS. Secondary outcomes will include DASS-21, FES, GS, and QLI. Participants' treatment acceptance and degree of satisfaction will also be measured. Participants will be assessed at pre-, post-treatment, and 6-month follow-up. Intention to treat and per protocol analyses will be performed. DISCUSSION This is the first study on FC for relatives of people with borderline personality disorder (BPD) compared to an active condition (TAU), and this is the first time relatives' and patients' data will be analyzed. In addition, it is the first study to test the efficacy of the program in Spain. This intervention could contribute to improving the efficiency and effectiveness of current treatment programs for relatives of people with BPD, help to decrease burden, and improve the family connection. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04160871. Registered November 15th 2019.
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Affiliation(s)
| | | | | | | | | | - Mercedes Jorquera
- ITA-PREVI (Personality Disorders Centre), Castellón, Valencia and Alicante, Spain
| | - Rosa Baños
- Universidad de Valencia, Valencia, Spain
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17
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Ilagan GS, Choi-Kain LW. General psychiatric management for adolescents (GPM-A) with borderline personality disorder. Curr Opin Psychol 2020; 37:1-6. [PMID: 32634737 DOI: 10.1016/j.copsyc.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
Abstract
While borderline personality disorder (BPD) has its onset in youth and is highly prevalent in young people, diagnosis and treatment are frequently delayed, leading to disruptions in development. The few treatments for this population are specialized, resource-intensive, and not widely implemented. Generalist treatments could broadly increase early intervention and access to care, at a less intensive level, when symptoms are milder and developmental arrests can be avoided. One generalist treatment for adults with BPD, General Psychiatric Management, has been adapted for adolescents (GPM-A). GPM-A can be flexibly implemented in different settings, and emphasizes psychoeducation, medicalization of the disorder, life-building activities, and conservative prescribing. This paper introduces GPM-A and proposes it serve as a primary intervention for adolescents with BPD.
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Affiliation(s)
- Gabrielle S Ilagan
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, MA, United States
| | - Lois W Choi-Kain
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
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18
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Krysinska K, Curtis S, Lamblin M, Stefanac N, Gibson K, Byrne S, Thorn P, Rice SM, McRoberts A, Ferrey A, Perry Y, Lin A, Hetrick S, Hawton K, Robinson J. Parents' Experience and Psychoeducation Needs When Supporting a Young Person Who Self-Harms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3662. [PMID: 32456022 PMCID: PMC7277421 DOI: 10.3390/ijerph17103662] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Self-harm in young people can have a substantial negative impact on the well-being and functioning of parents and other carers. The "Coping with Self-Harm" booklet was originally developed in the UK as a resource for parents and carers of young people who self-harm, and an adaptation study of this resource was conducted in Australia. This paper presents qualitative analysis of interviews with parents about their experiences and psychoeducational needs when supporting a young person who engages in self harm. METHODS The qualitative study drew on semi-structured individual and group interviews with parents (n = 19 participants) of young people who self-harm. Data were analysed using Thematic Analysis. RESULTS The analysis identified six themes: (1) the discovery of self-harm, (2) challenges in the parent-young person relationship, (3) parents' need to understand self-harm, (4) parents' emotional reactions to self-harm, (5) the importance of self-care and help-seeking among parents, and (6) the need for psychoeducational resources. CONCLUSION The study highlights the need for support for parents and carers of young people who engage in self-harm, including development and adaptation of resources, such as the "Coping with Self-Harm" booklet, of which an Australian version has now been developed.
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Affiliation(s)
- Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Sophie Curtis
- North Western Mental Health, Parkville, VIC 3050, Australia
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Nina Stefanac
- Orygen, Parkville, VIC 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Kerry Gibson
- School of Psychology, The University of Auckland, Auckland 1142, New Zealand
| | - Sadhbh Byrne
- Orygen, Parkville, VIC 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Pinar Thorn
- Orygen, Parkville, VIC 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Simon M Rice
- Orygen, Parkville, VIC 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | | | - Anne Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Yael Perry
- Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia
| | - Sarah Hetrick
- Orygen, Parkville, VIC 3052, Australia
- Department of Psychological Medicine, The University of Auckland, Auckland 1142, New Zealand
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
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Sutherland R, Baker J, Prince S. Support, interventions and outcomes for families/carers of people with borderline personality disorder: A systematic review. Personal Ment Health 2020; 14:199-214. [PMID: 31887229 DOI: 10.1002/pmh.1473] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/05/2019] [Accepted: 11/24/2019] [Indexed: 11/10/2022]
Abstract
It is clear from existent literature that families and carers of relatives and friends with borderline personality disorder (BPD) experience high levels of burden. Whilst family interventions are considered vital to improving the outcomes of those with a range of mental health difficulties, there has been limited development of direct interventions for carers of people with BPD, despite a high level of need. This systematic review aimed to appraise and synthesize the existing research evidence for interventions for carers of people with BPD. Ten studies were included that were directly related to six interventions for families and carers of people with personality disorder. The findings of these studies, whilst limited, do provide some initial evidence that interventions for carers may lead to significant outcomes for the participants, particularly in improving carer well-being and reducing carer burden. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ruth Sutherland
- Leeds Personality Disorder Managed Clinical Network, Leeds, UK
| | - John Baker
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Sharon Prince
- Leeds Personality Disorder Managed Clinical Network, Leeds, UK
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20
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Meshkinyazd A, Heydari A, Fayyazi Bordbar M. Lived Experiences of Caregivers of Patients with Borderline Personality Disorder: A Phenomenological Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:177-188. [PMID: 32309458 PMCID: PMC7153420 DOI: 10.30476/ijcbnm.2020.83358.1154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Having a patient with borderline personality disorder (BPD) in the family is a complicated and stressful experience. The caregivers' experiences and the problems they have in care of patient with BPD have remained unknown. The aim of this research was to explore the experiences of the caregivers while living with BPD patients in Iran. Methods This interpretive phenomenological research was performed on 10 caregivers of patients with BPD at Ibn-sina Hospital in Mashhad, Iran, in 2019. Purposeful sampling was used for sampling. Data were collected through semi-structured interviews and saturated after 16 interviews. The analysis of data was concurrently carried out using the method proposed by Diekelman (1989). The MAXQDA software (Ver.10) was used for data organization. Results The participants in this study were aged 25 to 55 years. After data analysis, three themes ("life in hell", "chain to the feet", and "black shadow of stigma") and six sub-themes ("disrupted from the life", "self-discrepancy", "care bottlenecks", "in the fence of restriction", "society dagger" and "resort to secrecy") emerged. Conclusion The results of this study showed that the caregivers of patients with BPD during the period of care were faced with a variety of problems. It is suggested that health policy-makers should pay more attention to the problems related to the mental health of caregivers.
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Affiliation(s)
- Ali Meshkinyazd
- Department of Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Seigerman MR, Betts JK, Hulbert C, McKechnie B, Rayner VK, Jovev M, Cotton SM, McCutcheon L, McNab C, Burke E, Chanen AM. A study comparing the experiences of family and friends of young people with borderline personality disorder features with family and friends of young people with other serious illnesses and general population adults. Borderline Personal Disord Emot Dysregul 2020; 7:17. [PMID: 32704374 PMCID: PMC7374854 DOI: 10.1186/s40479-020-00128-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Family and friends ('carers') of adults with borderline personality disorder (BPD) and carers of young people with other serious illnesses experience significant adversity but research on the experiences of caring for a young person with BPD features is sparse. This study aimed to: (i) describe the experiences of carers of young people with BPD features; (ii) compare them with published data assessing carers of young people with other serious illnesses and with adults from the general population. METHODS Eighty-two carers (M age = 44.74, SD = 12.86) of 54 outpatient young people (M age = 18.76, SD = 3.02) who met 3 to 9 DSM-IV BPD criteria completed self-report measures on distress, experiences of caregiving, coping, and expressed emotion. Independent-samples t-tests were employed to compare scores with those reported by convenience comparison groups of general population adults or carers of young people with eating disorders, cancer, or psychosis. RESULTS Carers of young people with BPD features reported significantly elevated levels of distress, negative caregiving experiences, and expressed emotion, as well as maladaptive coping strategies, compared with general population adults or carers of young people with other serious illnesses. CONCLUSIONS Carers of young people with BPD features experience elevated levels of adversity compared with their peers in the general adult population. This adversity is similar to, or greater than, that reported by carers of young people with other severe illnesses. Research is needed to clarify factors underlying adverse caregiving experiences and to develop and evaluate interventions to support carers of young people with BPD features. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trial Registry ACTRN12616000304437 on 08 March 2016, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369867.
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Affiliation(s)
- Mirra R Seigerman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Victoria K Rayner
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Martina Jovev
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sue M Cotton
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | | | | | | | - Andrew M Chanen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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Grenyer BFS, Bailey RC, Lewis KL, Matthias M, Garretty T, Bickerton A. A Randomized Controlled Trial of Group Psychoeducation for Carers of Persons With Borderline Personality Disorder. J Pers Disord 2019; 33:214-228. [PMID: 29505385 DOI: 10.1521/pedi_2018_32_340] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Carers of persons with borderline personality disorder (BPD) experience high burden. Treatment guidelines advocate involving carers in comprehensive therapy approaches. This study is a randomized controlled trial of group psychoeducation, compared to waitlist. Group psychoeducation involved 6-8 carers per group and focused on improving relationship patterns between carers and relatives with BPD, psychoeducation about the disorder, peer support and self-care, and skills to reduce burden. Carers were randomized into intervention (N = 33) or waitlist (N = 35). After 10 weeks, those in the intervention reported improvements in dyadic adjustment with their relative, greater family empowerment, and reduced expressed emotion, sustained after 12 months. There were also improvements in carers' perceptions of being able to play a more active role, such as interacting with service providers. This study demonstrates that providing structured group programs for carers can be an effective way of extending interventions to a group experiencing high burden.
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Affiliation(s)
- Brin F S Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Australia
| | - Rachel C Bailey
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Australia
| | - Kate L Lewis
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Australia
| | - Michael Matthias
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Australia
| | - Toni Garretty
- Family and Carer Mental Health Program, Il-lawarra Shoalhaven and South East Sydney Local Health Districts, New South Wales Ministry of Health, Australia
| | - Annemaree Bickerton
- Family and Carer Mental Health Program, Il-lawarra Shoalhaven and South East Sydney Local Health Districts, New South Wales Ministry of Health, Australia
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23
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Betts J, Pearce J, McKechnie B, McCutcheon L, Cotton SM, Jovev M, Rayner V, Seigerman M, Hulbert C, McNab C, Chanen AM. A psychoeducational group intervention for family and friends of youth with borderline personality disorder features: protocol for a randomised controlled trial. Borderline Personal Disord Emot Dysregul 2018; 5:13. [PMID: 30065842 PMCID: PMC6060555 DOI: 10.1186/s40479-018-0090-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/05/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Caring for a person with borderline personality disorder is associated with poor outcomes including elevated psychological distress and burden. This study will compare the effectiveness of two brief psychoeducational programs for carers of youth presenting for early intervention for borderline personality disorder features. The protocol for this study is presented here. METHODS The study is a single-centre parallel group, randomised controlled trial. As a family unit, relatives, partners and friends ('carers') are randomly allocated to one of two treatment arms to receive either an online borderline personality disorder psychoeducation program, or both the online psychoeducation group and a face-to-face group program, Making Sense of Borderline Personality Disorder. Carers are assessed at baseline and follow-up (4 weeks after the intervention). It is expected that participants who received the combined group and online programs will have better outcomes than those who received the online program alone. The primary outcome is carer burden, assessed using the negative appraisal subscales of the Experience of Caregiving Inventory. Secondary outcomes include positive experiences of caregiving, coping, self-rated personality disorder knowledge, psychological distress, expressed emotion and quality of life. DISCUSSION This will be the first published evaluation of a psychoeducational intervention for carers of youth with borderline personality disorder features using a randomised controlled trial design. The results have the potential to inform clinicians and carers about the effectiveness of brief interventions designed to support families and friends of young people with borderline personality disorder, and what medium those interventions should utilise. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trial Registry ACTRN12616000304437 on 08 March 2016.
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Affiliation(s)
- Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, (Locked Bag 10), Parkville VIC, Melbourne, 3052 Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jessie Pearce
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Ben McKechnie
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Louise McCutcheon
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, (Locked Bag 10), Parkville VIC, Melbourne, 3052 Australia
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Sue M. Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, (Locked Bag 10), Parkville VIC, Melbourne, 3052 Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, (Locked Bag 10), Parkville VIC, Melbourne, 3052 Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Victoria Rayner
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, (Locked Bag 10), Parkville VIC, Melbourne, 3052 Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Mirra Seigerman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Catharine McNab
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, (Locked Bag 10), Parkville VIC, Melbourne, 3052 Australia
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Andrew M. Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, (Locked Bag 10), Parkville VIC, Melbourne, 3052 Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
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Fossati A, Somma A. Improving Family Functioning to (Hopefully) Improve Treatment Efficacy of Borderline Personality Disorder: An Opportunity Not to Dismiss. Psychopathology 2018; 51:149-159. [PMID: 29486480 DOI: 10.1159/000486603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/26/2017] [Indexed: 11/19/2022]
Abstract
People having intimate relationships with persons suffering from borderline personality disorder (BPD) - for instance, members of their family - are likely to be involved in stormy, roller coaster relationships. Thus, they may feel overwhelmed by extreme, unpredictable feelings and situations, even when they do not suffer from any mental disorder or have no problems with mentalization. As a consequence of living with a BPD relative, family members often experience an emotional and financial burden, and may blame themselves for their relative's illness or for not being able to do more to help. This can lead to emotional pain including anxiety, guilt, anger, frustration, despair, and hopelessness. Available evidence suggests a possible usefulness of family interventions for relatives of BPD persons. Starting from these background considerations, a qualitative review of the published literature on family interventions for relatives of BPD persons was carried out. The main findings concerning specific contents and available effectiveness data of psychoeducational family interventions, family skills training, and mentalization-based family programs are reported, in the perspective of 3 family intervention scenarios: (a) taking care of the family of origin of the BPD person; (b) taking care of the new family that the BPD person has started; (c) helping the BPD person to be an effective parent.
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Affiliation(s)
- Andrea Fossati
- Vita-Salute San Raffaele University, Milan, Italy.,San Raffaele Turro Hospital, Milan, Italy
| | - Antonella Somma
- Vita-Salute San Raffaele University, Milan, Italy.,San Raffaele Turro Hospital, Milan, Italy
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